Month: February 2016

Huppakee Gone!

The Monday evening NTR broadcast of the documentary about the End of Life Clinic shows, according to Victor Lamme, professor of Cognitive Neuroscience, that the Dutch euthanasia practice is on a slippery slope.

Victor Lamme is Professor of Cognitive Neuroscience at the University of Amsterdam (UvA) and the author of, among other things, “De Vrije Wil Bestaat Niet”

In a documentary broadcast Monday by NTR, the End of Life Clinic very proudly presented three cases of euthanasia. Excerpts of this documentary had been shown earlier in the programme The World Keeps Turning, where the clinic’s work was highly praised; how ‘beautiful’ it all was. ‘Horrible’ seems to me the more appropriate term.

The euthanasia doctor found in her pronunciation of the word ‘huppakee’ sufficient evidence for a clearly present desire to die

It has become very clear now that the Dutch euthanasia practice has landed on a slippery slope and is now used to solve very different problems than unbearable suffering. A most obvious case in point was that of Hannie Goudriaan, a woman with semantic dementia. This woman had written a will in 2010, in which she had declared that she no longer wanted to live if as a result of her dementia she would no longer know who she was and would be housebound. The End of Life Clinic decided that this point had been reached. They got strong support from the husband, who spoke for her.

Anyone who has seen the documentary could feel the pressure Hannie was under to stick to her once completed advance directive. She was able to drive, visit a skating competition, and have a drink in a pub. But her husband had no intention to visit her if she would end up in a home, and the euthanasia doctor found in the pronunciation of the word ‘huppakee’ sufficient evidence for a clear and present desire to die.

The disappearing desire to die

Should we keep people with dementia to their previously completed Living Will? Many people resent the prospect of dementia. It is therefore increasingly common to prepare an advance directive like Hannie did. What is thereby forgotten is that once that time has come, this desire to die most often disappears, and demented elderly are often far from unhappy.

A comparable situation – and easier to investigate – is that of patients with locked-in syndrome, a brain injury that causes total paralysis and whereby people can only blink their eyes. Nearly every normal person says that if he would ever end up in this situation, he would like to put an end to his life. It appears, however, that these patients rate their quality of life on average with a 7, similar to the score given by the average student. People simply adapt very quickly to a new situation, how miserable that situation may be.

In addition: dementia changes the brain. He or she thus becomes literally a different person; with other norms, feelings, and desires. He is then simply no longer the person who signed at one point in the past the advance directive. To hold demented people to their living will is as weird as saying to an 18-year old that he must become a fireman, simply because he said that once when he was eight years old. People change, and nowhere faster than in the context of dementia.

Euthanasia Marketing

Finally, it is highly questionable how ‘free’ people are when they complete such an advance directive. The pressure on the elderly is continuously increasing. They are being told that health care costs are being wasted in the last years of life, and that they wouldn’t want to be a burden on their children. And that it is really so very ‘beautiful’ to take matters into your own hands.

The elderly are being told how ‘beautiful’ it is to take matters into one’s own hands

That kind of social pressure can become very forceful, consciously or unconsciously; and there is ample scientific evidence for that. Do not underestimate at all the power of the “euthanasia marketing” of recent years, with associations like “Uit Vrije Will”, which do not shy away from using marketing ploys such as the use of celebrity endorsement, proudly displaying Dutch celebs like Hedy d’Ancona, Mies Bouwman, Frits Bolkestein and Dick Swaab on their websites. That way it becomes more or less the norm to end your life when it becomes somewhat less appealing.

What problem is euthanasia really supposed to solve? Elderly take up time, and demand money and effort, which modern society doesn’t want to muster. In the same NTR broadcast we see the centenarian Ans, who fully enjoys a day at sea. Her suffering mostly consist of the fact that no one takes her there anymore. Except on that last day.

It all comes eerily close to the famous scene from the science fiction film Soylent Green, where elderly people are encouraged to commit euthanasia after seeing a movie about how beautiful life on earth once was, a long time ago.

When Hannie gets the lethal injection she says ‘it is horrible’. It is the first time she says something else than “huppakee.” Her last words touch the essence.

Victor Lamme is Professor of Cognitive Neuroscience at the University of Amsterdam (UvA) and the author of, among other things “De Vrije Wil Bestaat Niet”.

[I translated this op-ed using google translate as a rough basis to save time, then corrected and improved the translation based on the original Dutch version]

It’s Euthanasia week. Monday, February 15 NTR broadcasted a documentary “End of Life Clinic” which caused a huge uproar in the (social) media.

Chris Rutenfrans, opinion editor of the Volkskrant. February 17, 2016.

Her doctor refused euthanasia because he never heard from her that she wanted euthanasia or wanted to die.

It is highly questionable whether Marcel Ouddeken and Hans Kema have done a favour to the support for euthanasia with their documentary “End of Life Clinic.” The broadcast by the NTR Monday has evoked so much horror that it could very well be a turning point in the euthanasia debate. Former journalist Wouke van Scherrenburg posted on Twitter: “I’ve dreamed about that woman in the chair and it was a gruesome dream.”

The viewer sees three cases of termination of life by a doctor at the End of Life Clinic, an institution that handles death requests of those whose requests are refused by their family physician (GP). The euthanasia of Hannie Goudriaan touched a particularly sensitive nerve, as is apparent from the responses. Hannie Goudriaan suffers from semantic dementia, a form of dementia that primarily affects the speech center in the brain. Her ability to verbally express herself is limited, and is in the documentary largely restricted to the expression “huppakee, gone!”

Her life is terminated on the basis of an advance directive from 2010. It is very obvious that she doesn’t know anything anymore about this. Her family physician has refused euthanasia because he has never heard from her that she wants euthanasia or that she wants to die. He says that he has not been sufficiently supported by the SCEN-physician [note translator: SCEN is the official Dutch Support and Consultation Service for Euthanasia] and the neurologist he consulted. But the doctor of the End of Life Clinic maintains that in the seven conversations he has had with her, she has made it clear to him that with respect to her wish to die by euthanasia, she “knows what she wants.”

Hannie receives, seated in a chair, a lethal doses of medication. Her death takes place in front of the camera. Hans Beerekamp writes in the NRC Handelsblad on Tuesday: “The images of how she receives a lethal injection seated in her armchair at home will be shown around for years to come, at home and abroad. In the Netherlands, the formula ‘Huppakee. Gone” now counts as a valid expression when establishing consent, and for determining the presence of unbearable and hopeless suffering.”

This is clearly not an emergency situation of hopelessness. The weekend before her death, you see Hannie Goudriaan enjoying a day at Thialf [note translator: a skating ring] in Heerenveen. You also see how she skillfully drives her car while her husband, who insists on the termination of her life, sits next to her passively, as he has done for 35 years.

Execution

Rob Bruntink, a palliative care expert, writes on his blog Bureau MORBidee: “Never before have I seen a euthanasia that looked like an execution. A slaughter. But the husband found it beautiful. And the doctor found it worthy, “because she didn’t snore in the process.”

Bruntink says he can imagine that this documentary can represent a turning point in the thinking about euthanasia in the Netherlands. “Many people call this outright murder. I got a message from my mother with the question ‘was this real or was it fake?’ That is, I think, illustrative of the astonishment this broadcast evoked across the country. ”

Bruntink himself avoids the use of the term “murder”, “because it keeps the discussion away from what it should really be about: do we as a society really want to go in this direction?”

He believes that the supply of euthanasia creates the demand and that it makes other options superfluous. He is convinced that palliative care, where pain management and relief of suffering are central, is less well developed in the Netherlands because of the option of euthanasia.

His work in hospices, specialized in terminal care, have taught Bruntink that people have difficulty judging what they can handle in the future. “At the hospice, they often arrive waving their euthanasia requests, but only one in a hundred will also receive euthanasia. The others find again and again that life is still quite bearable. You could say that euthanasia prevents that people continue to mature.”

Euthanasia prevents that people continue to mature

Bruntink finds the report of the Advisory Committee Completed Life chaired by Paul Schnabel encouraging: “It says that we should worry about each other and increase investment in health care for the elderly, especially for people with dementia and chronic psychiatric patients.”

Chris Rutenfrans is opinion editor of the newspaper.

[Translated by me (TL) with google translation for a rough basis to save time, then correction and improvement of the text]